Breastfeeding rates cost the country billions

by Crystal Phend

Poor compliance with breastfeeding recommendations costs the nation at least $13 billion each year, with nearly all of the cost related to infant morbidity and mortality, according to a comprehensive economic analysis.

If 90% of new mothers followed guidelines for six months of exclusive breastfeeding for their children, an estimated 911 deaths would be prevented annually, said authors Melissa Bartick, MD, MSc, of Harvard Medical School, and Arnold Reinhold, MBA, of the Alliance for the Prudent Use of Antibiotics, both in Boston.

Even 80% adherence would save $10.5 billion and prevent 741 deaths each year, they reported online in Pediatrics.

Taking action to help more families to follow the guidelines, such as by creating a national infrastructure to support breastfeeding, would likely be cost-effective, Bartick and Reinhold said.

Prior analyses that included fewer pediatric conditions affected by breastfeeding suggested a more modest potential savings of $3.6 billion if breastfeeding rates rose to meet the Healthy People 2010 objectives for initiation (75%) and six-month duration (50% any breastfeeding, 17% exclusive breastfeeding).

However, that data was based on actual breastfeeding rates collected by the infant formula industry and incorrectly assumed that this reflected exclusive breastfeeding, Bartick and Reinhold wrote.

So with national data now available from the CDC on breastfeeding, they aimed to get a more accurate estimate of the economics of breastfeeding.

The CDC’s National Immunization Survey found actual breastfeeding rates in 2005 were 74.1% for initiation and the early postpartum period, 42.9% for any breastfeeding at six months, 12.3% for exclusive breastfeeding at six months, and 21.5% for any breastfeeding at 12 months.

“Exclusive breastfeeding” meant only breast milk — no water, infant food, juice, formula, cow’s milk, or sugar water.

Bartick and Reinhold determined direct and indirect costs of illness and premature death as assessed in a 2007 Agency for Healthcare Research and Quality analysis of the impact of breastfeeding on a host of maternal and childhood diseases.

The excess annual cost in 2007 dollars associated with the current poor levels of adherence compared with 90% compliance was:

* $4.7 billion and 447 excess deaths due to sudden infant death syndrome.
* $2.6 billion due to 249 excess deaths from necrotizing enterocolitis.
* $1.8 billion due to 172 excess deaths from lower respiratory tract infections.
* $908 million due to otitis media.
* $601 million due to atopic dermatitis.
* $592 million due to childhood obesity.

The largest proportion of these costs — 74% — was associated with premature deaths, although the price for more common conditions, such as otitis media and childhood obesity, was still substantial, the researchers noted.

There wasn’t enough data available for type 2 diabetes to estimate the effect of breastfeeding duration, “although these costs are partially represented in the obesity analysis,” the researchers said.

Furthermore, few of these estimates were based on exclusive breastfeeding for six months and most erred on the conservative side, so the projections may actually be an underestimate, they explained.

“Substantial gains could be made with exclusive breastfeeding for four months and any breastfeeding at six months,” they concluded.

Crystal Phend is a MedPage Today Senior Staff Writer.

Originally published in MedPage Today. Visit for more pediatrics news.

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  • pat

    non-compliance? Do women have no reproductive choice left?

    I agree, it is best. But there are always exceptions to the rule.

  • stargirl65

    If they really want to promote this then they will need to pay all the working moms for 6 months off work to breast feed their children. It is very hard to breast feed and work. In some industries it is near impossible. Most workplaces are not supportive of breastfeeding or pumping. Many moms are already over stressed with their jobs, other children, and running a home and cannot take the added stress of trying to breast feed.

  • Amy Tuteur, MD

    This study is based on nothing more than fanciful “estimates” of theoretical costs. It is utterly reliant on pretending that correlation in breastfeeding rates with disease rates means that breastfeeding causes or prevents diseases.

    Breastfeeding rates rise in concert with income and education. So does infant health. It is irresponsible to claim that breastfeeding itself, as opposed to the confounding factors associated with increased maternal education and income, is wholly responsible for differences in death and disease.

    The “costs” are in large part absurd. Not a single infant death has been definitively linked to failure to breastfeed, yet the authors insist that 911 deaths each year can be attributed to failure to breastfeed. The putative “lost wages” of these unfortunate infants do not represent any type of cost saving at all. Society does not lose money when an infant dies, so claiming that we would save more than $9 billion dollars (out of a total savings of $13 billion) is ridiculous, and renders the authors’ entire argument suspect.

    • Butch Phelps

      I agree with you Amy. To put all the blame on breastfeeding puts unnecessary pressure on the mom, when in reality it has more to do with income and living conditions. Yes I believe breastfeeding is much better for the baby and the mother, but in America a woman can be treated like an outcast if she tries at work. The we must look at what the mom can afford to eat because what she takes in, so does the baby. We certainly work to educate moms about eating good food, but if she cannot afford it, she is not. My daughter just had a baby last November and the grandmothers and great grandmothers has been telling my daughter how inconvenient breastfeeding is and she should just feed the baby formulas instead. So there are many reasons, but income and lifestyle contribute the most.

  • ninguem

    Not disputing anything Amy, but wondering. The correlation of income and education with breastfeeding.

    Does that apply to foreign-born? Usually I see immigrants, who may well be boor and not well educated, but made it to our shores. They seem to breastfeed, as their relatives did in the old country. But maybe just my little corner of the country.

  • Bill Seitz

    $10M per SIDS event? Really?

  • AnnR

    I agree with Pat – purge the phrase ‘non-compliance’ from any association with breast feeding!

  • Doc D

    I read this study last week, and thought it was “advocacy” research. The authors didn’t spend a lot of time talking about competing life circumstances or individual limitations on accomplishing the goal of 6 months. These notional studies of “90% compliance” are rarely helpful to patients and can create a sense of failure we then have to work with the patient to overcome. It’s good to note that there are substantial benefits to breastfeeding, but the optimal plan needs to occur one-on-one.

  • Mary Brighton, MS, RD

    Just a comment from where I see it (I used to work at WIC as a dietitian and I was also trained to educate women about choosing to breastfeed and how to make it a success.
    I think some of the problems in non compliance with 6 long-term breastfeeding come from discharging new mothers home from the hospital before breastfeeding is well established. In addition there is not a lot of follow-up for moms at home when something happens during the breastfeeding process that could lead to stopping.
    There is too much influence from the formula companies giving out coupons and samples of free formula. You know what happens when a mom/or couple is frustrated with the breastfeeding process…and there is that free sample sitting there at home waiting to be used? Of course, they use it..and then that is the beginning of the end for the breastfeeding.
    Breastfeeding exclusively for 6 months can be a real possibility, with support for moms and partners that want to make it a reality.
    Also, one last point, I have heard of doctors who tell moms to stop breastfeeding for reasons that are not correct. (example-mom being on a short dose of antibiotics…you could pump and throw away the breastmilk and then continue breastfeeding after the medicine is out of the system). Doctors are not always trained nor aware of the correct advice to give breastfeeding mothers when certain medical situations arise.
    Mary Brighton, MS, RD

  • Reta Russell Hougton

    Non-compliance?? That makes me feel great and like I have done something wrong. I tried to breast feed my children but was not able to produce enough them. Now, I have this slapped in my face like I am a failure. This is an insult and makes me sound like a bad mother. I think your writer could have used another title that was offensive.

  • Anonymous

    “non compliance ” in relationship to breast feeding! Will you medical specialist ever take yourselves down off of your pedistals and TRY to include yourself with the rest of the human race.. This is an insulting term even with the best of intentions! And once again women are put into the role of needing to be controlled!

    I wonder how many doc’s will be “non compliant” with the federal government when the new laws kick in… and perhaps you will be brought up on charges too ’cause that’s were this reteoric is going… If someone is “non compliance” then the inplication is that a “rule or law” has been broken…. What a mess!!!

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